DONATION RESPONSE FORM Practical support, empowerment, hope. OPTION ONE: Single Contribution. My gift of: $500 will provide practical support for 6 families for one year $250 will provide emergency food hampers for 10 families $100 will purchase 4 emergency food cards for single parent families $50 will purchase a child’s elementary school supplies other amount or purpose, please specify: $_______________________________________ Use the credit card payment method below, or enclose a cheque payable to 1Up Single Parent Resource Centre. OPTION TWO: Monthly Contribution I want to make a difference by joining the MONTHLY GIVING CLUB by pre-authorized debit, using my chequing account (please include VOID cheque). Once per month I will gift: $10 $25 $89 (supports 15 families/year) other $________ GIFT PROCESS: Please charge my credit card: Visa MasterCard AMEX Card number ____________________________________________ Expiration Date _____|_____|_____ Authorized Card Signature ________________________________________ Please use the following name(s) in all acknowledgements: Name 1 ________________________________ Name 2 __________________________________ Or, I (we) wish to remain ANONYMOUS I (we) would like information on making a planned gift. Today’s Date:_____________________ Name: ______________________________________ Signature_________________________________ Address________________________________________ City______________ Postal Code____________ Telephone_______________________ Email________________________________________________ MAIL to: 1Up, 602 Gorge Road East, Victoria BC V8T 2W6, or FAX to: 250-361-3554, or PHONE Trevor at 250-385-1114 or GIVE ONLINE via www.1-up.ca Thank you for your kind and generous support. Donations of $20 and higher will automatically receive a charitable tax receipt. Charitable tax #10798 2472 RR0001.
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